In the human body, the abdomen is separated from the chest cavity by a muscle called the diaphragm. The diaphragm is dome shaped and has an opening called the hiatus. The esophagus passes through the hiatus into the stomach. A hiatal hernia occurs when the muscle surrounding the hiatus becomes weak. The upper part of the stomach projects through the diaphragm into the chest cavity.
Experts concur that pressure on the stomach leads to the development of a hiatal hernia. Possible causes are an inherited weakness in the muscles surrounding the hiatus or having a very large hiatus. Injury to the area of the diaphragm can be a cause. Increased pressure on this area can result from coughing, vomiting, straining with a bowel movement, or lifting heavy objects. People over the age of 50 years, or who are obese, or have a history of smoking have an increased risk of developing a hiatal hernia.
A person with a small hiatal hernia will not experience symptoms. However, signs of a large hiatal hernia are recurrent heartburn and acid reflux, belching, chest pain, and nausea. After seeking the medical attention of a gastroenterologist, a person can expect to be evaluated with a barium x-ray or an endoscopy. Prior to the barium x-ray procedure, the patient drinks a chalky substance which coats the upper digestive tract. The barium in the substance acts to silhouette the esophagus, stomach, and upper part of the small intestines. During an endoscopy, a flexible tube is inserted through the patient’s mouth and gently passed to the esophagus and stomach. The gastroenterologist is able to look for signs of a hiatal hernia.
Three types of medication are prescribed to treat the associated acid reflux. Antacids provide quick relief. The H-2 receptor blockers work to reduce the production of stomach acid. Proton pump inhibitors actually block acid production and allow the esophagus to heal. Lifestyle changes such as eating several small meals throughout the day, limiting the intake of fatty foods, and avoiding foods that trigger heartburn can be beneficial.